I seem to be experiencing a flare because I have had severe hip pain now for several weeks. This may have been triggered by walking for too long on three consecutive days. Two weeks ago after a telephone appointment the rheumy told me to increase the prednisolone from 35 mg a day to 45 mg a day for two weeks which he hoped would settle things, but although it has improved my ability to walk slightly it has not altered the pain in the left hip and the pain and stiffness across the hips and the lower back. I wonder if it is bursitis or synovitis. I have been having some pain in the right temple but this is relatively mild and infrequent. I have been diagnosed with both GCA and PMR. I emailed the rheumy yesterday but have not heard back. Should I continue to take the higher dose of 45 mg a day or taper down to 40mg.?
why is my hip pain so severe?: I seem to be... - PMRGCAuk
why is my hip pain so severe?
Hello, personally I would have liked some sort of examination to rule out something like piriformis (or other) muscle issues, particularly because it occurred shortly after over-working of the area. Just whacking up the dose, over the normal level for PMR dose, feels a tad lazy to me and is exposing you to more high dose Pred possibly for an issue that is not resolvable by Pred. I’ve hip muscle issues recently that I left for too long and it affected my lower back. I had it sorted out by an osteopath. I’m not just saying this because my experience, it’s the association with your exercise and that on Pred we become so much more prone to injury.
Thanks SnazzyD. The rheumy did say he should examine me if everything has not settled in two weeks which goes along with what you are saying. I did wonder whether walking for some time might have damaged the muscles. I did not walk far but it took me nearly two hours because I could only walk very slowly. I will see if I can get an appointment with him.
In case it isn’t a rheumatological problem, I’d also go to your GP etc try other measures as PMRPro says rather than just waiting for the opinion of one person who has shown themselves to be relatively disinterested. In my experience rheumy’s aren’t experts in structural musculoskeletal issues so I wouldn’t rely just on them.
Regards your temple pain, I don’t know but it’s worth always being mindful of tension in the sternocleidomastoid muscles that can mimic some GCA symptoms as I found out just before I necked some Pred.
I think that is appallingly lazy - there are several things it could be and it needs a proper physical examination, possibly even an x-ray. An emergency appointment with someone at the GP practice - a paramedic or nurse would do - and a referral to a walk-in x-ray service would be a good start to rule things out.
Perhaps I should have said a new GP in the practice was very thorough and I had an X-ray which showed nothing untoward, according to the radiographer, but only very slight OA on the spine side of the hip. She also did blood tests which showed there might be something happening with my ovaries but this was followed swiftly by an ultrasound of the ovaries which showed everything was normal. Walking and moving around are painful and did not immediately respond to the increase in steroids but after 8 or 9 days I find that I can walk just a little more normally, although I am not sure why! Perhaps the increased press are having some effect. I will try for an appointment with the rheumatologist but in the meantime wonder whether to stay on the higher dose.
That's OK then - that should have ruled out the nasties I was most concerned about.
Yes I hope so. Thanks PMRpro. I wonder if it is bursitis or synovitis which might take longer to sort out. I am not sure whether they respond to prednisolone. The rheumy thinks I may not be so responsive to steroids both positive effects and side effects.
If it is bursitis, it often responds to oral pred but tends to need a lot or a long time. Especially if you have PMR as that seems to "feed" it. Steroids shots are a lot better.
Hi Raga, I really empathise with you as I have the same problem. Mine was sudden. I got up one morning and couldn’t bear weight on one leg. My rheumatologist ordered an X-ray over the phone , which came back with a two sentence report of mild to moderate osteoarthritis, which didn’t explain the severe pain. I requested an MRI, which he has ordered but I don’t have an appointment yet. But again, neither he or my GP have examined me. No one seems to put their hands on their patients anymore. He has me continuing to taper as he believes it’s mechanical, not inflammatory. It is extremely painful and I worry about avascular necrosis having been on prednisolone for nearly 8 years. I could have it privately but I have found the reports minimal in the past and my rheumatologist doesn’t take a look at the original screen. So I am just giving it a few more days to see if the NHS one comes through. So here I am finally investing in a walker and a rollater, and feeling pretty miserable in constant pain. Hope you get yours sorted soon.
Thanks for your reply Nightingales. Your pain does sound very similar. My GP did examine my hip and could see no signs of redness or swelling and gave me a physio appointment at the surgery and she could see nothing much wrong but thought it could be bursitis. It is pretty miserable as you say and I have even wondered about a stairlift because our bathroom is upstairs so I am having to climb the stairs many times each day. I have emailed the rheumatologist but not heard back about whether I should taper or stay on the higher dose for now. I hope your pain eases soon.
Thank you Raga. It’s such a mystery isn’t it? I have trochanteric pain syndrome, which includes bursitis. Steroid injections work well on that for me. But this is worse than what I have had before. Very best wishes
I hope you get sorted out. I had an x-ray on the spot and an MRI with contrast ordered and had it within a week. They were to the point of ruling out tumors/masses, did blood work to rule out infection..after truly ruling everything out I found PMR by the 1000th google search and demanded to be treated for it..oddly, my ESR is high now after 6 weeks on 15 mg and it wasn't before..I actually to to the GP today and gonna beg for him to raise it..still have 25% pain on most days..Mine was sudden, too..literally after 5 hours of sleeping it just was there when I woke up..although mine was more painful to the touch than weight bearing problems. Praying for you
Thank you sidra. I have had PMR for nearly 8 years now and although I think it adds to the inflammation I think the hip has something wrong structurally. It’s good you could get your MRI so quickly. It seems a lot of people have almost overnight symptoms of PMR. I had to up the prednisolone to 20 at first as 15 wasn’t enough.
An x-ray should show a structural problem. I had hip problems before too after falling on a boulder and they diagnosed a torn labrum (It was an educated guess after an MRI) so have been getting intra-articular steroid injections over over 7 years, which were like a miracle. I wonder if PMR goes to our already injured or problematic areas..would make sense kind of..because that where my pains are..neck and hip. Yes, he better up mine today, considering my ESR went up and I am at like 75% better overall. Again, hoping and praying for you..at least when you know what it is, the mental part gets better
My severe hip pain preceded PMR. XRay showed no OA, so I was sent for an MRI which showed inflammation and effusion. I wasn't offered anything other than a cortisone injection which I refused due to it being during lockdown as it has to be done under a general anaesthetic, I was told, and the needle put deep into the hip joint. However my GP referred me to physio which was brilliant. A really thorough exam and some gentle exercises that helped a bit, crutches and later, sticks. But it didn't get much better until PMR and GCA hit a few months later (ironically) and I was put on 60mg pred. Even then, (despite immediate relief of my PMR/GCA symptoms) it took another 3 months before my hip was feeling much better. Now, 18 months later, I very occasionally get the odd twinge if I twist round, for example, so I still have to be careful. The best thing I found was to use a footstool and to stop crossing my legs (which hurt too much anyway, now it doesn't, I have to remind myself!).Hope this helps.
mine is osteoarthritis in left hip & also ossification (growing bone on the muscles) showed up on x-Ray. But pain just behind hip was diagnosed as trochanteric bursitis & im waiting to have a steroid injection. My GP gave me a top to toe examination, the appointment lasted an hour, but I have multiple health problems. Suggest you consult a doctor, as it could be so,etching completely different!! The extent of my OA was masked by the pred, & as I taper it’s worse & worse! Joys of getting down to a lower dose of pred!!
I have had a painful left hip for about a year now. Pain on standing and walking, fine when sitting and laying down. Dr. had it X-rayed last May, comments on my on-line record "abnormal but expected"!My hubby had a fall while in hospital for tests last June and hit his head causing another brain bleed, he also has Parkinsons and has become very slow moving and has urinary incontinence, I am his main carer, we pay for a carer for 1hr in the morning (£24).
I decided to see the Dr again about my hip, but couldn't get a f2f appt, so opted to see a nurse practitioner, who actually examined me!
She has decided I have OA and gave me a prescription for Tramadol, I am not keen to take that so will continue with Paracetamol for the time being.
I am on 7mg pred, been reducing from 20mg since 2015 with lot's of flares.
We are moving soon, maybe next month, to Scotland to be near our 2 daughters who both worked as carers when younger and want us nearer to be more helpful. I will see what the Scottish Drs make of my hip.
Good luck, Marcia
Where in Scotland? It is one of my options should I return from Italy! There are excellent support groups up there.
Hi , we are going to Helensburgh, Argyll & Bute, on the Clyde. My daughters live in Rhu which is 5 mins away. We lived in Rosneath for 29yrs when Hubby was at work, then when he retired we spent 9 yrs in Spain, Costa Blanca. Been in Wiltshire for 7 yrs now, but I need more help with hubby now.Not sure the Scottish climate will help with OA, but will like being nearer our daughters, no grandchildren unfortunately.
Especially on the west coast!!! It's looking at the weather forecast in Edinburgh and Yorkshire that keeps me here. My two are far apart so it would have to be one or the other really. I think I'd rather live in Scotland but not sure I could put up with that daughter long term ... OTOH, I suppose I could emply my granddaughter as a carer which she enjoyed when she tried it but there were problems with the client.
Are you really sure it is bursitis? Steroids can and do demineralize bones. I would suggest seeing an ortho if possible
If you mean osteoporosis - it is painless unless there is a fracture which was why both Snazzy and I mentioned x-rays. Which have been done.
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